Preserving the left arm vein in cases of hemodialysis access generating left internal mammary artery steal syndrome.

In patients undergoing chronic hemodialysis (HD) through an arm arteriovenous fistula (AVF), coronary insufficiency can occur if the patient undergoes a coronary artery bypass graft (CABG) using the ipsilateral internal mammary artery (1-4). Therefore, the creation of a new AVF after CABG should avoid using the arm ipsilateral to the side where the internal thoracic artery was used. In cases where coronary syndrome appears when this advice is not followed, treatment should be offered aimed at overcoming the hemodynamic interference between the diminished coronary supply through the left or right internal mammary artery by closure of the existing fistula, with or without temporary central venous line insertion until the maturation of a new fistula. We suggest a different approach by moving only the arterial inflow site of the AVF to the controlateral subclavian artery, but in addition, leaving the well functioning venous outflow tract intact. In cases of left internal mammary steal it is achieved by creating a conduit running from the right subclavian artery to the left cephalic vein; therefore, creating a new arterial inflow source, connected to the existing functioning old venous outflow tract to maintain an immediately functioning new fistula without a coronary steal.

Arthropod poisons and the cardiovascular system.

Animal poisons induce myocardial damage after envenomation. The cardiac manifestations after black widow spider bite are rarely observed and their prognostic significance are not known. Hymenoptera induce anaphylactic manifestations commonly observed in adults with previous coronary artery disease although myocardial involvement is observed in a few without previous heart disease. The mechanism of cardiac involvement after scorpion envenomation has been elucidated, however after widow spider bite or hymenoptera stings the mechanism of myocardial damage of those without previous heart disease is not clear.

Unusual coronary collateral circulation: filling of a totally occluded left anterior descending artery by direct continuity from a left posterior descending artery. A case report.

A patient with an unusual coronary collateral circulation is presented. The left anterior descending artery, which was totally occluded proximally, was filled directly by a continuation of the left posterior descending artery. A thallium stress test revealed normal perfusion in the territory of the left anterior descending artery.

Abnormal coronary perfusion in experimental scorpion envenomation.

Perfusion defects and left ventricular dilation after experimental scorpion envenomation were evaluated in five dogs. Left Left ventricular dilation was observed in three dogs and right ventricular dilation in one other, in scans immediately after envenomation. Perfusion defects were inferred from scans in four dogs. The data are strongly suggestive of coronary hypoperfusion, and the mechanics of abnormal coronary flow after scorpion envenomation are discussed.

Endogenous fusicoccin-like ligand revealed in higher plants by radioreceptor and radioimmunoassays.

Radioimmuno- and radioreceptor assays were developed for quantitating fusicoccin-like substances in plants. FC-like ligands were found in cultured horseradish roots (70-90 pmol/g) and headed cabbage leaves (9-11 pmol/g). Detection of FC-like ligands in sterile root culture further argues in favour of endogenous fusicoccin representing a new type of phytohormone.

Abnormal thallium stress test and normal coronary angiograms: catheterization and clinical characteristics.

Left ventricular end-diastolic pressure at rest, left ventricular ejection fraction, thallium segmental abnormalities, as well as sex, age and presence of diabetes mellitus, hypertension, hypercholesterolemia and smoking excess were analyzed in 40 patients with abnormal thallium stress test and normal coronary angiograms. Of these patients, 25 had elevated left ventricular end-diastolic pressure and "low normal" ejection fraction (group 1), while the other 15 had normal left ventricular end-diastolic pressure and "high normal" ejection fraction (group 2). The left ventricular end-diastolic pressure was 18.1 +/- 4.5 mm Hg in group 1 vs. 8.5 +/- 2.4 mm Hg in group 2 (P < 0.000). The ejection fraction was 57.6 +/- 8.3% in group 1 vs. 63.9 +/- 9.1% in group 2 (P < 0.05). There was no difference between the groups in relation to the abnormal segment on thallium stress tests, aged and sex. Although the number of patients was too small for meaningful statistical analysis, most of the patients with diabetes mellitus, hypertension, hypercholesterolemia or smoking history were in group 1. Thus, the patient population with abnormal results on radionuclide exercise tests and angiographically normal coronary arteries probably comprises two groups: a) patients with decreased diastolic and relatively decreased systolic performances which might reflect coronary flow disturbances, and b) patients with normal diastolic and systolic performances, probably reflecting "true false positive thallium stress test".

[R proteins as an integral index of the action on the body of industrial allergens in an experiment on white rats]. / R-belki kak integral'nyi pokazatel' deistviia na organizm promyshlennykh allergenov v éksperimente na belykh krysakh.

P proteins were just obtained from white rats and a method to testify them with the help of highly stable anti-P serum was worked out. Normal titres of P proteins are 1:1600 and 1:3200. Different models of sensitisation to the industrial allergens (delivered intracutaneously, by inhalation, into trachea in various doses and concentrations) were used in trials of the method. P protein level appeared to correlate with the sensitisation degree estimated by specific allergy tests. The highest P protein titer is due to the toxic allergic conditions (up to 1:102400), the minimal to sensitization of threshold (up to 1:12800) level. Provocative inhalation test in sensitized rats induced an increase of P protein titer as delayed hypersensitivity was forming.

Variations in blood supply to the anterior interventricular septum: incidence and possible clinical importance.

The variations of the blood supply to the anterior interventricular septum in a series of 1,089 patients are described. Special attention has been given to variations and frequency of occurrence of the septal perforators originating from the left anterior descending artery. These variations may have clinical significance in this era of coronary angioplasty and coronary bypass surgery.

Echocardiographic and radionuclide angiographic observations following scorpion envenomation by Leiurus quinquestriatus.

The echocardiographic and radionuclide angiographic abnormalities in children after scorpion envenomation with L. quinquestriatus, were evaluated. Five children were severely hypertensive, one of them in respiratory failure and another had pulmonary edema. The results revealed poor global contractility 12-15 hr after the sting in three patients. The radionuclide angiograms also revealed poor contractility with low ejection fraction. There was enzymatic evidence of myocardial damage. The changes observed in the echocardiograms and radionuclide angiograms were attributed to catecholamine induced myocardial ischemia. The abnormalities observed suggest that systolic dysfunction plays a role in the pathogenesis of heart failure in scorpion envenomation, in addition to a decrease of left ventricular compliance and increased impedance to left ventricular emptying. The beneficial effects of nifedipine in hypertension and other cardiovascular manifestations justify the routine use of afterload reduction in children with cardiovascular manifestations after scorpion envenomation.

[Long-term follow-up of prosthetic heart valves].

257 patients underwent single or double heart valve replacement between 1964-1986. In 141 (55%) after isolated mitral valve replacement, operative mortality was 14.8% and after 5, 10, 15 and 20 years, actuarial survival was 84%, 70%, 59% and 44%, respectively. In 70 who underwent isolated aortic valve replacement, operative mortality was 7.1% and after 5, 10, 15 and 20 years, actuarial survival was 85%, 85%, 72% and 72%. In 46 who underwent combined aortic and mitral replacement, operative mortality was 4.3% and after 5, 10 and 15 years, actuarial survival was 78%, 71% and 71%.

Cor pulmonale due to adenoidal or tonsillar hypertrophy or both in children. Noninvasive diagnosis and follow-up.

Four children, aged 1 to 3 1/2, were first seen with cor pulmonale, pulmonary edema and severe respiratory distress due to chronic upper airway obstruction secondary to adenoidal or tonsillar hypertrophy or both. Arterial blood gas values, electrocardiograms and chest x-ray films were compatible with cor pulmonale. Echocardiography (four cases) and radionuclide angiography (two cases) showed severe right ventricular and right atrial dilation with reduced right ventricular ejection fraction. Following surgery, all four children improved; their echocardiographic and radionuclide findings returned to normal. Cardiac catheterization, traditionally performed in such cases, was unnecessary. The diagnosis and follow-up of this syndrome are adequately performed noninvasively.

Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment.

Ventricular function was evaluated using radionuclide ventriculography in 27 children with oropharyngeal obstruction and clinical features of obstructive sleep apnea. Their mean age was 3.5 years (9 months to 7.5 years). Conventional clinical assessment did not detect cardiac involvement in 25 of 27 children; however, reduced right ventricular ejection fraction (less than 35%) was found in 10 (37%) patients (mean: 19.5 +/- 2.3% SE, range: 8-28%). In 18 patients wall motion abnormality was detected. In 11 children in whom radionuclide ventriculography was performed before and after adenotonsillectomy, right ventricular ejection fraction rose from 24.4 +/- 3.6% to 46.7 +/- 3.4% (P less than 0.005), and in all cases wall motion showed a definite improvement. In five children, left ventricular ejection fraction rose greater than 10% after removal of oropharyngeal obstruction. It is concluded that right ventricular function may be compromised in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy, even before clinical signs of cardiac involvement are present.

ST elevation in leads V1 to V4 caused by isolated right ventricular ischemia and infarction.

A patient with isolated right ventricular ischemia and infarction is presented. ST elevation in leads V1 to V4 mimicking anteroseptal myocardial infarction was recorded at admission and during episodes of chest pain later on. Noninvasive and invasive workup suggested isolated right ventricular infarction and ischemia due to an occluded small and nondominant right coronary artery.

[The role of A-cells in affecting the immunostimulating effect of F(ab')2-fragments]. / Rol' A-kletok v realizatsii immunostimuliruiushchego deistviia F(ab')2-fragmentov.

The immunoregulatory effect of F(ab')2 fragments on normal rabbit IgG and that preincubated with A-cells from spleen have been compared. Both products were tested for their ability to enhance primary immune response of rabbit spleen cells to SRBC. It was demonstrated that low molecular mass product appeared after F(ab')2 fragments incubation with A-cells at 37 degrees C and possessed immunostimulating activity similar to that of initial F(ab')2 fragments. In addition, it was shown that F(ab')2 reduction to monovalent Fab' fragment with the following alkylation of SH-group abolished the ability of Fab' fragment to enhance the immune response. It may signify that half cystein Fab' fragment residue is essential for processing of the fragment in A-cells and (or) for immune response enhancement.

Virus-induced blast transformation of lymphocytes and its inhibition by F(ab1)2 fragments of human IgG.

Blast transformation of lymphocytes from persons immunized by vaccines against tick-borne Japanese encephalitides, in response to stimulation by homologous viral antigens was studied. 3H-Thymidine incorporation into lymphocytes was completely inhibited by F(ab1)2 fragments of normal human IgG containing no antibody to the viruses examined. A correlation of the inhibitory action of F(ab1)2 fragments on lymphocyte transformation induced by viruses and phytohaemagglutinin was observed.

Coexistence of hypertrophic obstructive cardiomyopathy and mitral annular calcification: proposed etiologic relationship.

A case of combined hypertrophic obstructive cardiomyopathy and mitral annular calcification is reported. The characteristic features of both entities were clearly demonstrated by thorough noninvasive examinations. It is proposed that the association of the two conditions is not coincidental but that mitral annular calcification, by narrowing of the left ventricular outflow tract, can result in the development of hypertrophic obstructive cardiomyopathy. Mitral annular calcification should possibly be added to the other causes of pressure overload of the left ventricle--such as hypertension and valvular or discrete subvalvular aortic stenosis--as a potential etiology of secondary hypertrophic obstructive cardiomyopathy.